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1.
Chinese Journal of Surgery ; (12): 409-423, 2022.
Article in Chinese | WPRIM | ID: wpr-927617

ABSTRACT

Organ transplantation is the most effective treatment for end stage organ failure,and voluntary donation after citizen's death is the only source of transplanted organ in China.Clinically,transplantation organ protection technology plays a critical role in improving the quality of transplantation organs and the prognosis of recipients.On the basis of domestic and worldwide basic research and clinical practice and according to the Oxford evidence classification and GRADE system,the experts organized by Organ Transplantation Doctor Branch of Chinese Medical Doctor Association,Organ Transplantation Group in Surgery Branch of Chinese Medical Association and China Liver Transplant Registry Scientific Committee had compiled and published the Chinese Expert Consensus on Organ Protection of Transplantation(2016 edition) for liver,kidney,pancreas,small intestine,heart,lung transplantation organs.With the support of China Liver Transplant Registry,National Center for Healthcare Quality Management in Liver Transplant,National Quality Control Center for Donated Organ Procurement,National Clinical Research Center for Orthopedics & Sports Medicine & Rehabilitation and National Trauma Medical Organ Protection Committee and combined with recent domestic and worldwide clinical practice and research progress for organ transplantation and organ protection,the Chinese Expert Consensus on Organ Protection of Transplantation(2022 edition)(hereinafter referred to as the consensus) has been formulated in 2022.This edition of the consensus focuses on updating the technical progress and evidence-based medicine of organ procurement,organ preservation,organ transport,and quality evaluation in clinical practice.Additionally,protection of composite tissue for transplantation,mainly including limb graft,has also been included.The organ protection strategy recommended in this consensus aims to promote scientific and standardize clinical organ transplantation work.


Subject(s)
Asians , Consensus , Humans , Organ Preservation , Organ Transplantation , Registries , Tissue and Organ Procurement
2.
Arq. bras. oftalmol ; 84(2): 163-169, Mar,-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153124

ABSTRACT

ABSTRACT Purpose: The aim of this study was to evaluate the physical and chemical characteristics of coconut water and to analyze the use of coconut water solution for the conservation of human corneas. Methods: This was an experimental and controlled study performed at the Eye Bank of the General Hospital of Fortaleza. The coconut water-based solution was prepared at the Goat Seed Technology Laboratory of the Department of Veterinary Medicine of the State University of Ceará. Discarded corneas from the Eye Bank were divided into two groups for sequential experiments: G1, coconut water-based solution (experimental group), and G2, conservative treatment with OPTISOL GS® (control group). The osmolality of corneas in G1 was analyzed sequentially at 275, 300, 325, 345, 365, and 400 mOsm/L. The viability of the corneas was determined by specular microscopy and biomicroscopy on the first, third, and seventh days. Results: Corneas preserved in a solution of 365 and 345 mOsm/L had a transparency of 8 mm until the third day and had diffuse edema in the periphery, central folds, and partial epithelium loss until the seventh day. The 365-mOsm/L solution was associated with the worst results during follow-up. Corneas placed in Optisol-GS retained their original aspects. Conclusions: Coconut water-based preservative partially maintained corneal transparency and epithelial integrity, especially during the first three days of follow-up. The coconut water-based solutions used were not effective for use as preservatives in a human eye bank.(AU)


RESUMO Objetivos: As características físico-químicas e o baixo custo da água de coco foram fundamentais para o este estudo. Analisar o uso de solução a base de água de coco como meio de conservação de córneas humanas em banco de olhos. Métodos: Estudo experimental e controlado realizado no Banco de Olhos do Hospital Geral de Fortaleza. Utilizou-se solução à base de água de coco preparada no laboratório de Tecnologia de Sêmen de Caprinos do Departamento de Medicina Veterinária da Universidade Estadual do Ceará. Foram usadas córneas de descartes divididas em dois grupos: G1 (Conservante com água de coco) - grupo experimental e G2 (grupo Conservante com OPTISOL GS®) grupo controle, em experimentos sequenciais. A osmolaridade do G1 foi analisada sequencialmente com 275, 300, 325, 345, 365 e 400 mOsm/L. A viabilidade das córneas foram realizadas por microscopia especular e biomicroscopia nos 1º, 3º e 7º dias. Resultados: As córneas em solução de 365 e 345 mOsm/L apresentavam transparência nos 8mm centrais até o 3º dia, com edema em toda periferia, dobras centrais e edema 2+, com perda parcial do epitélio até 7º dia, sendo o de maior osmolaridade com melhor transparência durante o seguimento. Grupo com 275, 300 e 400 mOsm/L, córnea opaca, edema difuso, perda total do epitélio no 3º dia. As córneas em Optisol mantiveram seus aspectos. Conclusões: O conservante à base de água de coco manteve em parte a transparência corneana e a integridade epitelial, especialmente nos primeiros 3 dias de seguimento. A solução conservante com água de coco nas formulações utilizadas não se mostrou eficaz para o uso em banco de olhos humanos.(AU)


Subject(s)
Humans , Organ Preservation/methods , Biotechnology/methods , Organ Preservation Solutions/chemistry , Foods Containing Coconut , Eye Banks/organization & administration , Intervention Studies
3.
Chinese Medical Journal ; (24): 181-186, 2021.
Article in English | WPRIM | ID: wpr-921253

ABSTRACT

BACKGROUND@#Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation.@*METHODS@#HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.@*RESULTS@#In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806).@*CONCLUSION@#According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.


Subject(s)
Biomarkers , Delayed Graft Function , Graft Survival , Humans , Kidney/physiology , Kidney Transplantation/adverse effects , Organ Preservation , Perfusion , Retrospective Studies , Tissue Donors
4.
Article in Chinese | WPRIM | ID: wpr-880419

ABSTRACT

This paper introduced a liver normothermic machine perfusion repair and assessment system. This system consists of a liver normothermic machine perfusion device, a fluorescence imaging system and a tissue oxygen detector. The normothermic machine perfusion device can continuously perfuse the donor liver and monitor and control the perfusion parameters in real time. The fluorescence imaging system can detect the indocyanine green metabolized by the liver to evaluate the microcirculation and the metabolism function of hepatocytes. The tissue oxygen detector can monitor the change of oxygen partial pressure of liver tissue in real time to evaluate the state of cell oxygen consumption.


Subject(s)
Humans , Liver , Liver Transplantation , Living Donors , Organ Preservation , Perfusion
5.
Prensa méd. argent ; 106(7): 413-418, 20200000. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1366937

ABSTRACT

Antecedentes: Hasta la década del 80 los pacientes con esta patología eran intervenidos quirúrgicamente. A partir de 1997 la Cleveland Clinic publica un estudio basado en la quimioradioterapia en el cáncer avanzado de orofaringe con resultados similares a los de la época anterior, pero con preservación del órgano. En nuestro medio no existe bibliografía que analice estadísticamente los resultados y los factores que lo condicionaron. Objetivo: Evaluar los resultados con quimioradioterapia secuencial en el cáncer avanzado de la región orofaríngea. Lugar de aplicación: Hospital de atención terciaria Diseño: Prospectivo no randomizado Material y metodo: Desde Enero del 2002 al 30 de diciembre del 2004 se estudiaron 60 pacientes, 55 pertenecían al sexo masculino, con edad media de 60 años, el 76.7% eran T III y los restantes T IV con tumores malignos de la región orofaríngea mediante quimioradioterapia secuencial. Resultados: La supervivencia a 152 meses fue del 30.1%. El análisis univariado, demostró que el estadío, con p<0,001, la reducción con p=0,010 y la cirugía de rescate con p=0,028 fueron las únicas variables estadísticamente significativas, mientras la edad, el sexo y la localización no tuvieron los mismos resultados. En el análisis multivariado, el estadío con una p< 0.001, el sexo con una p=0.016 y la reducción con una p=0.024 resultaron ser estadisticamente significativos. Conclusiones: El tratamiento de los tumores de la región orofaríngea, en estadíos III y IV, mediante quimioradioterapia secuencial alcanzaron resultados similares a los tratados con cirugía seguida de radioterapia, pero con preservación del órgano


Background: Until the 80th decade, patients with advanced oropharyngeal cancer were surgically treated. In 1997 the Cleveland Clinic published similar results with chemoradiotherapy but preserving the organ. In our country there are not papers analyzing those results and conditional factors. Objective: Evaluation of sequential chemoradiation results in advanced oropharyngeal cancer Setting: Public tertiary care Hospital of tumours Design: Prospective not randomized. Population and methods: From January 2002 to December 2008, 60 patients were analysed, 55 of them were male with a mean age of 60, 76.7% TIII/IV oropharyngeal carcinomas treated with sequential chemoradiation. Results: The overall 152 months of survival was 30.1%. Univariate analize showed stage p<001, reduce of lesion p:0.010 and rescue surgery p:0.028 were statiscally significative. Age, gender and subsite had not similar results. In multivariate analize only stage p:0.001, gender p: 0.016 and reduce of lesion p:0.024 resulted statiscally significative. Conclusions: Sequential chemoradiation of III and IV stage tumours of oropharyngeal area have similar long terms results than those treated with surgery plus radiation but with organ preservation


Subject(s)
Humans , Adult , Middle Aged , Aged , Organ Preservation , Radiotherapy , Toxicology , Oropharyngeal Neoplasms/therapy , Risk Factors , Drug Therapy , Neoplasm Staging , Multivariate Analysis
6.
Rev. Col. Bras. Cir ; 47: e20202610, 2020. tab
Article in English | LILACS | ID: biblio-1136566

ABSTRACT

ABSTRACT Brazil, like most countries in the world, experiences the expansion of extended criteria donors, mainly due to the aging of the population and the obesity epidemic. Concerns regarding the quality of these organs along with the vast territorial areas of the country compromise the utilization rate of livers from donors and aggravate the discrepancy between the number of liver transplants performed and the needed. Ex situ liver machine perfusion offers superior preservation for livers from extended criteria donors, limiting cold ischaemia time and offering the possibility of evaluation of their function before transplantation as well as the reconditioning of marginal organs. Objections such as the financial cost, difficulty in transporting the device between hospitals, and demand of trained professionals in the handling of the device must be pondered with the possibility of increasing the number of transplants and the utilisation rate of donor organs. The optimal use of this resource, through the careful selection of donors and the appropriate technical and scientific knowledge, can ensure an effective and successful implementation of this technology.


RESUMO O Brasil, como a grande parte dos países no mundo, convive com a expansão de doadores de órgãos de critério estendido, principalmente devido ao envelhecimento da população e à epidemia de obesidade. Dúvidas em relação à qualidade desses órgãos juntamente com as longas extensões territoriais do país comprometem a taxa de utilização de fígados de doadores e agravam a discrepância entre o número de transplantes hepáticos realizados e o necessário. A máquina de perfusão hepática oxigenada ex situ oferece preservação superior para fígados de doadores de critério estendido, limitando o tempo de isquemia fria e oferecendo a possibilidade de avaliação da função antes do transplante bem como o recondicionamento de órgãos de qualidade limítrofe. Objeções como o custo financeiro, dificuldade de transporte do dispositivo entre hospitais e a demanda de profissionais treinados para o manuseio devem ser apreciadas diante da possibilidade do aumento do número de transplantes e a maior taxa de utilização de órgãos de doadores. A otimização na utilização desse recurso, por meio da seleção cuidadosa de doadores, e o conhecimento técnico-científico adequado podem garantir a implementação eficaz e bem sucedida dessa tecnologia.


Subject(s)
Humans , Organ Preservation , Perfusion , Tissue Donors , Liver Transplantation , Liver, Artificial , Brazil , Liver
7.
Acta cir. bras ; 35(6): e202000603, 2020. graf
Article in English | LILACS | ID: biblio-1130651

ABSTRACT

Abstract Purpose To compare Fructose-1,6-Bisphosphate (FBP) to Histidine-Tryptophan-Ketoglutarate (HTK) in liver preservation at cold ischemia. Methods Male rats (Sprague-Dawley: 280-340g) divided into three groups (n=7): Control; Fructose-1,6-bisphosphate (FBP); Histidine-Tryptophan-Ketoglutarate (HTK). Animals underwent laparotomy-thoracotomy for perfusion of livers with saline. Livers were removed and deposited into solutions. Mitochondria were isolated to determine State 3 (S3), State 4 (S4), Respiratory Control Ratio (RCR) and Swelling (S). Liver enzymes (AST, ALT, LDH) were determined in solution. At tissue, Malondialdehyde (MDA) and Nitrate (NOx) were determined. All parameters were analyzed at 0.6 and 24 hours of hypothermic preservation. Statistics analysis were made by Mann-Whitney test (p<0.05). Results Regarding ALT, there was a difference between FBP-6h/HTK-6h, lower in HTK. Regarding AST, there was a significant difference between FBP-24h/HTK-24h, lower in FBP. Regarding NOx, there was a difference between 0h and 6h, as well as 0h and 24h for both solutions. Regarding S3, there was a significant difference in 24h compared to Control-0h for both solutions, and a significant difference between FBP-6h/FBP-24h. Regarding S4, there was a difference between Control-0h/HTK-24h and FBP-24h/HTK-24h, higher in HTK. There was a difference between Control-0h/FBP-24h for Swelling, higher in FBP. Conclusion Fructose-1,6-Bisphosphate showed better performance at nitrate and aspartate aminotransferase compared to histidine-tryptophan-ketoglutarate.


Subject(s)
Animals , Rats , Cold Ischemia , Organ Preservation , Tryptophan , Allopurinol , Rats, Sprague-Dawley , Organ Preservation Solutions , Fructose , Glucose , Glutathione , Histidine , Liver , Mannitol
8.
Rev. colomb. nefrol. (En línea) ; 6(2): 152-158, jul.-dic. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1093039

ABSTRACT

Resumen La enfermedad renal crónica es un problema de salud pública con una alta morbilidad y mortalidad. El trasplante renal es una de las actuales alternativas terapéuticas. Se incluyen en este artículo 12 trabajos publicados referentes a la contaminación del líquido de preservación en trasplante renal, 4 reportes de caso, y 8 estudios de prevalencia. En este estudio la prevalencia de contaminación de líquido de preservación para cualquier microorganismo varió entre 17,43 % a 59,72 %, mientras que para los limitados al reporte de Candida sp, la frecuencia varió de 1,69 % a 8,57 %. En los reportes de caso, todos fueron asociados a la infección por Candida sp, con arteritis de la arteria renal y pérdida del injerto como las complicaciones más frecuentes. En nuestra institución, Hospital de Especialidades de las Fuerzas Armadas N°1, de un total de 59 pacientes trasplantados se aisló al menos un microorganismo en 20 casos (28,17 %). Con estos resultados sugerimos que la contaminación del líquido de preservación es un fenómeno frecuente en trasplante renal, sin embargo al no poseer publicaciones en las que se describan las complicaciones asociadas a la infección por otros microorganismos, creemos que la contaminación por Candida sp, a pesar de no tener una gran frecuencia, es clínicamente la más relevante.


Abstract Chronic kidney disease is a public health problem with high morbidity and mortality, kidney transplantation being one of the current therapeutic alternatives. In12 published works concerning the contamination of the preservation fluid in kidney transplant, four case reports, and eight prevalence studies. The prevalence of preservation liquid contamination for any microorganism ranged from 17.43% to 59.72%, while for those limited to the Candida sp report, the frequency varied from 1.69% to 8.57%. In the case reports, all were associated with Candida infection, with renal artery arteritis and graft loss as the most frequent complications. In our institution, of a total of 59 transplant patients, at least one microorganism was isolated in 20 cases (28.17%). Preservation fluid contamination is a frequent phenomenon in kidney transplantation. However, since no publications are describing the complications associated with infection by other microorganisms, we could say that contamination by Candida sp, despite not having a high prevalence, it is clinically the most relevant.


Subject(s)
Humans , Male , Female , Organ Preservation , Kidney Transplantation , Colombia , Renal Insufficiency, Chronic
9.
Cambios rev. méd ; 18(2): 96-105, 2019/12/27. graf., tab.
Article in Spanish | LILACS | ID: biblio-1099763

ABSTRACT

La mayor parte de los potenciales do-nantes de órganos proceden de las Uni-dades de Emergencias y Cuidados Inten-sivos, lugar en donde se ubican la ma-yoría de los pacientes con trastorno neu-rológico agudo y grave1.Durante el diagnóstico de muerte ence-fálica (ME) comienza el auténtico man-tenimiento del donante, ya que hay mo-mentos críticos, como la realización del test de apnea. Durante la fase previa al es-tablecimiento de ME el paciente ha sido tratado de manera agresiva con todos los métodos a nuestro alcance, muchos de ellos encaminados a preservar la perfu-sión cerebral manitol, tiopental sódico, etc., nos encontramos a menudo con po-tenciales donantes con gran inestabilidad hemodinámica e importantes alteraciones del medio interno1.El mantenimiento del donante multior-gánico constituye un desafío para el equipo de la Unidad de Cuidados In-tensivos. Este proceso implica poner en práctica el conocimiento total del manejo de disfunción multiorgánica en un paciente muerto. El tiempo de dete-rioro de los órganos juega también un rol en el tratamiento de todas las compli-caciones que se presentan en este tipo de pacientes. La adherencia a un protocolo de manejo es fundamental para lograr que un mayor número de donantes se trasladen a quirófano para la extracción de órganos viables2.


INTRODUCTION:Most of the potential organ donors come from the Emergency and Intensive Care Units, where most of the patients with acute and severe neurological disorder are located1.During the diagnosis of brain death, the authentic maintenance of the donor begins, as there are critical moments, such as the apnea test. Since during the pre-establishment phase of brain death the patient has been treated aggressi-vely with all the methods at our dis-posal, many of them aimed at preser-ving cerebral perfusion manitol, thio-pental sodium, etc., we often find our-selves with potential donors with high hemodynamic instability and significant changes in the internal environment1.The maintenance of the multiorgan donor is a challenge for the Intensive Care Unit team. This process involves putting into practice the total knowledge of the management of multi-organ dys-function in a dead patient. The time of deterioration of the organs also plays a role in the treatment of all the complica-tions that occur in this type of patients. Adherence to a management protocol is essential to ensure that a greater number of donors are transferred to the opera-ting room for the extraction of viable organs2.


Subject(s)
Humans , Male , Female , Organ Preservation , Tissue Donors , Transplantation , Tissue and Organ Procurement , Brain Death , Organ Transplantation , Respiration, Artificial , Therapeutics , Vasodilator Agents , Cadaver , Enteral Nutrition , Medication Therapy Management , Organism Hydration Status , Heart Arrest , Hemodynamics , Hypothermia
10.
Int. j. morphol ; 37(3): 1107-1110, Sept. 2019. tab
Article in English | LILACS | ID: biblio-1012404

ABSTRACT

A small amount of acetic acid (AA), a common preservative, has been shown to increase contamination in cadaveric tissue, while larger concentrations can lead to the tissue becoming hard, especially in fresh brains. This study attempted to optimize the concentration of AA to be used in the cranial cavity in order to produce the most realistic consistency and color. Six adult cadaveric heads were preserved with descending glacial AA at concentrations of 98.5 %, 80 %, 60 %, 40 %, 20 %, and 10 %. The samples were kept at 5 °C for 14 days. The brain cortex was then dissected with a suction tube and forceps to reveal the underlying brain tissue for inspection. Color change, cortical firmness, pia mater stickiness, and participant satisfaction were evaluated. The color of the brains in all concentrations was slightly yellow. However, the temporal area of the brain preserved using 20 % AA was significantly more pink. The pia mater of the brain cortex of all samples was firm and difficult to pry apart, with the firmest consistency being in the brain tissue preserved using 98.5 % AA. The brain tissue in all samples had a liquid-like consistency. The brains preserved in AA at a concentration greater than 60 % yielded higher satisfaction scores. We conclude that acetic acid has a role in brain preservation for skull base surgery training and recommend AA concentrations higher than 60 % for maximal participants satisfaction.


Se ha demostrado que una pequeña cantidad de ácido acético (AA), un preservante común, aumenta la contaminación en el tejido del cadáver, mientras que mayores concentraciones pueden endurecer el tejido, particularmente en cerebros frescos. Este estudio intentó optimizar la concentración de AA en la cavidad craneal para producir una consistencia y coloración cerebral más cercanos a la realidad. Seis cabezas cadavéricas adultas se conservaron con AA glacial descendente en concentraciones de 98,5 %, 80 %, 60 %, 40 %, 20 % y 10 %. Las muestras se mantuvieron a 5 °C durante 14 días. Luego se diseccó la corteza cerebral con un tubo de succión y pinzas para observar e inspeccionar el tejido cerebral subyacente. Se evaluaron el color, la firmeza cortical, la viscosidad y adherencia de la piamadre y la reacción de los participantes ante esta conservación. El color de los cerebros en todas las concentraciones fue ligeramente amarillo. Sin embargo, el área temporal del cerebro, conservada con un 20 % de AA, fue significativamente más rosada. La piamadre de la corteza de todas las muestras fue de consistencia firme y difícil de separar; una mayor resistencia se observó en el tejido cerebral preservado con 98,5 % de AA. La consistencia del tejido cerebral en todas las muestras era líquida. Los cerebros conservados en AA a una concentración superior al 60 % recibieron puntuaciones de satisfacción más elevadas. Concluimos que el ácido acético desempeña un papel en la preservación del cerebro, permitiendo el entrenamiento en cirugía de base de cráneo, por lo que recomendamos concentraciones de AA superiores al 60 % para una satisfacción máxima por parte de los participantes.


Subject(s)
Humans , Adult , Organ Preservation , Surgical Procedures, Operative/education , Brain/anatomy & histology , Acetic Acid/chemistry , Cadaver
11.
Rev. bras. oftalmol ; 78(4): 227-232, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013679

ABSTRACT

Abstract Objective: The aim of this study is to identify the causes for discarding corneas at the Eye Bank of the Federal District in Brasilia, Brazil, and describe the social and demographic variables and Causa Mortis of cornea donors from 2014 to 2017. Methods: We conducted an exploratory and social-epidemiologic descriptive study regarding cornea donation. The data base information was obtained from the corneal donor's medical records analysis. All of the potential donors' records (cause of death, cause of cornea discard, month of donation, age, gender, and time of death, corneal enucleation and preservation), from 2014 to 2017 were included in the study. Results: We looked at 1,574 corneal donor notifications. Demographic characteristics displayed significant differences in gender distribution (male, 74.8% and female, 25.2%), and the average donor age was 40 ± 15.9 years. 25% of the causes of death were from cardiovascular disease followed by 19.6% from sharp or blunt instrument injury, 14.2% resulted from multiple traumas. We described 3,074 donated corneas from the DF Eye Bank, where 2.6% has not been uptaken. Of those 3,074 corneal tissues, nearly 60% (n=1,836) have been transplanted and 40% (n=1,238) were discarded. Regarding the causes of discard, 68% (n=841) were due to positive or indeterminate serological blood tests and 39% (n=486) because of matureness (expired medium guaranteed period of corneal preservation). Conclusions: Specific issues such as violent causes of death, gender disproportion and total time of corneal processing can be better managed to reduce procurement times, and availability, of corneal tissue for transplantation.


Resumo Objetivo: Identificar as causas do descarte de córneas no Banco de Olhos do Distrito Federal, em Brasília, Brasil, descrever as variáveis sociodemográficas e causa de morte dos doadores de córnea de 2014 a 2017. Métodos: Foi realizado um estudo descritivo exploratório e socioepidemiológico sobre as doações de córnea. As informações da base de dados foram obtidas a partir da análise dos prontuários dos doadores. Todos os registros dos potenciais doadores (causa da morte, causa do descarte, mês de doação, idade, sexo e tempo de morte, enucleação e preservação da córnea), de 2014 a 2017, foram incluídos no estudo. Resultados: Analisamos 1.574 notificações de doadores. Características demográficas apresentaram diferenças significativas na distribuição por sexo (masculino, 74,8% e feminino, 25,2%). A idade média dos doadores foi de 40 ± 15,9 anos. 25% das causas de morte foram de doenças cardiovasculares, seguidas de 19,6% de perfurações por arma de fogo e 14,2% de múltiplos traumas. Descrevemos as 3.074 córneas doadas ao Banco de Olhos do DF e onde apenas 2,6% não foram captadas. Dos 3.074 tecidos da córnea, quase 60% (n = 1.836) foram transplantados e 40% (n = 1.238) foram descartados. Quanto às causas de descarte, 68% (n = 841) foram devidas a exames sorológicos positivos ou indeterminados e 39% (n = 486) por tempo de vencimento (período máximo de preservação da córnea). Conclusões: Questões específicas como causas violentas de morte, desproporção de gênero e tempo total de processamento da córnea podem ser melhor gerenciadas para reduzir o tempo de captação e a disponibilidade de tecido para transplante.


Subject(s)
Humans , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/statistics & numerical data , Cause of Death , Corneal Transplantation/statistics & numerical data , Patient Selection , Eye Banks/statistics & numerical data , Organ Preservation , Tissue and Organ Procurement/standards , Medical Records , Epidemiology, Descriptive , Cornea
12.
Arq. bras. oftalmol ; 82(1): 56-61, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-973867

ABSTRACT

ABSTRACT Purpose: The porcine eye is frequently used as a research model. This paper analyzes the effect of different storage methods on the transparency of pig crystalline lens. Methods: A spectral transmission curve (from 220 to 780 nm) for the crystalline lens was determined experimentally after storage in different conditions: saline solution, formalin, castor oil, and freezing at -80°C. The total transmission in the visible spectrum, which was used as an index of transparency, was calculated from these curves. For comparative purposes, fresh lenses were evaluated and used as controls. Results: Storing the porcine crystalline lens in saline solution or castor oil resulted in a transparency loss of approximately 10% after 24 h and storage in formalin resulted in a loss of nearly 30%. Storage by freezing at -80°C for 4 weeks maintained the transparency of the crystalline lens; the spectral transmission measured immediately after defrosting at room temperature coincided exactly with that of the freshly extracted lens. Conclusions: The transparency of porcine crystalline lens is affected by the storage method. The visible spectrum is the most affected, evidenced by the effect on the transparency and consequently the amount of light transmitted. The results show that freezing at -80°C maintains the transpa rency of the crystalline lens for at least 4 weeks.


RESUMO Objetivos: Olho de porco é frequentemente usa do como modelos de pesquisa. Este estudo analisa o efeito de di ferentes métodos de armazenamento na preservação da transparência do cristalino de porco. Métodos: Uma curva de transmissão espectral (de 220 até 780 nm) para o cristalino foi experimentalmente determinada após armazenamento em diferentes condições: solução salina, formol, óleo de mamona e congelamento a -80°C. Transmissão total do espectro visível, que foi usada como um índice de transparência foi calculada a partir dessas curvas. Para fins comparativos, lentes frescas foram avaliadas e usadas como controles. Resultados: O armazenamento do cristalino suíno em solução salina ou óleo de mamona resultou uma perda de transparência de aproximadamente 10% após 24 h e o armazenamento em formol resultou uma perda de quase 30%. O armazenamento por congelamento a -80°C durante 4 semanas manteve a transparência do cristalino; a transmissão espectral medida imediatamente após o descongelamen to à temperatura ambiente coincidiu exatamente com a da lente extraída recentemente. Conclusão: A transparência do cristalino suíno é afetada pelo método de armazenamento. O espectro visível é o mais afetado, evidenciado pelo efeito sobre a transparência e consequentemente a quantidade de luz transmitida. Os resultados mostram que o congelamento a -80°C mantém a transparência do cristalino suíno por pelo menos 4 semanas.


Subject(s)
Animals , Organ Preservation/methods , Lens, Crystalline/anatomy & histology , Reference Values , Spectrophotometry/instrumentation , Spectrophotometry/methods , Swine , Time Factors , Ultraviolet Rays , Castor Oil/chemistry , Reproducibility of Results , Models, Animal , Formaldehyde/chemistry , Freezing , Lens, Crystalline/physiology , Lens, Crystalline/diagnostic imaging , Light
13.
J. bras. pneumol ; 45(4): e20170288, 2019. graf
Article in English | LILACS | ID: biblio-1040273

ABSTRACT

ABSTRACT Liquid perfluorocarbon (PFC) instillation has been studied experimentally as an adjuvant therapy in the preservation of lung grafts during cold ischemia. The objective of this study was to evaluate whether vaporized PFC is also protective of lung grafts at different cold ischemia times. We performed histological analysis of and measured oxidative stress in the lungs of animals that received only preservation solution with low-potassium dextran (LPD) or vaporized PFC together with LPD. We conclude that vaporized PFC reduces the production of free radicals and the number of pulmonary structural changes resulting from cold ischemia.


RESUMO O perfluorocarbono (PFC) líquido tem sido estudado experimentalmente como uma substância adjuvante na preservação de enxertos pulmonares durante o período de isquemia fria. O objetivo deste estudo foi avaliar se o PFC vaporizado (e não instilado) também atuaria como protetor de enxertos pulmonares em diferentes tempos de isquemia fria. Realizamos análise histológica e dosamos o estresse oxidativo em pulmões de animais que receberam somente uma solução de preservação com low-potassium dextran (LPD, dextrana com baixa concentração de potássio) ou PFC vaporizado associado a LPD. Concluímos que o PFC vaporizado reduziu a produção de radicais livres e provocou menor número de alterações estruturais pulmonares decorrentes do período de isquemia fria que o uso de LPD isoladamente.


Subject(s)
Humans , Organ Preservation/methods , Lung Transplantation/methods , Oxidative Stress/drug effects , Cold Ischemia/methods , Fluorocarbons/pharmacology , Lung/drug effects , Reference Values , Time Factors , Reproducibility of Results , Dextrans/pharmacology , Organ Preservation Solutions , Glucose/pharmacology , Lung/pathology
14.
Article in English | WPRIM | ID: wpr-765790

ABSTRACT

Pancreatic solid pseudopapillary neoplasm (SPN) is a rare tumor that is mostly benign, but a surgical resection is recommended. Pancreatic SPN has a relatively well-demarcated margin and lymph node metastases are rare. The prognosis of pancreatic SPN is relatively good. Therefore, minimally invasive surgery (MIS) is often available. When a distal pancreatectomy is performed for SPN located at the pancreatic body or tail, it is believed to preserve the spleen. MIS with preservation of spleen not only helps the patient recover after surgery, but also does not worsen the oncology results compared to open surgery with or without a splenectomy. Recently, robotic surgery has expanded gradually. Therefore, it is expected that MIS with spleen preservation will become more common for pancreatic SPN.


Subject(s)
Humans , Laparoscopy , Lymph Nodes , Minimally Invasive Surgical Procedures , Neoplasm Metastasis , Organ Preservation , Pancreatectomy , Pancreatic Neoplasms , Prognosis , Spleen , Splenectomy , Tail
15.
Article in English | WPRIM | ID: wpr-762304

ABSTRACT

No abstract available.


Subject(s)
Organ Preservation , Rectal Neoplasms
16.
Article in English | WPRIM | ID: wpr-762303

ABSTRACT

Standard use of neoadjuvant chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemotherapy in locally advanced rectal cancer has tremendously improved oncologic outcomes over the past several decades. However, these improvements come with costs of significant morbidity and poor quality of life. Along with developments in imaging techniques, clinical experience and evidence have identified a certain subgroup of patients that have exceptionally good clinical outcomes while preserving quality of life. Driven by patient demand and interest in preserving quality of life, numerous organ preservation treatment strategies for managing rectal cancer are rapidly evolving. Herein, the flow of research in organ preservation strategies and counter arguments are discussed.


Subject(s)
Chemoradiotherapy , Chemotherapy, Adjuvant , Consolidation Chemotherapy , Humans , Induction Chemotherapy , Organ Preservation , Quality of Life , Rectal Neoplasms
17.
Article in English | WPRIM | ID: wpr-762302

ABSTRACT

PURPOSE: We evaluated the oncologic outcomes of organ-preserving strategies in patients with rectal cancer treated with preoperative chemoradiotherapy (PCRT). METHODS: Between January 2008 and January 2013, 74 patients who underwent wait-and-watch (WW) (n = 42) and local excision (LE) (n = 32) were enrolled. Organ-preserving strategies were determined based on a combination of magnetic resonance imaging, sigmoidoscopy, and physical examination 4–6 weeks after completion of PCRT. The rectum sparing rate, 5-year recurrence-free survival (RFS), and overall survival (OS) were evaluated. RESULTS: The rectum was more frequently spared in the LE (100% vs. 87.5%, P = 0.018) at last follow-up. Recurrence occurred in 9 (28.1%) WW and 7 (16.7%) LE (P = 0.169). In the WW, 7 patients had only luminal regrowth and 2 had combined lung metastasis. In the LE, 2 (4.8%) had local recurrence only, 4 patients had distant metastasis, and 1 patient had local and distant metastasis. Among 13 patients who indicated salvage surgery (WW, n = 7; LE, n = 11), all in the WW received but all of LE refused salvage surgery (P = 0.048). The 5-year OS and 5-year RFS in overall patients was 92.7% and 76.9%, respectively, and were not different between WW and LE (P = 0.725, P = 0.129). CONCLUSION: WW and LE were comparable in terms of 5-year OS and RFS. In the LE group, salvage treatment was performed much less among indicated patients. Therefore, methods to improve the oncologic outcomes of patients indicated for salvage treatment should be considered before local excision.


Subject(s)
Chemoradiotherapy , Follow-Up Studies , Humans , Lung , Magnetic Resonance Imaging , Neoplasm Metastasis , Organ Preservation , Phenobarbital , Physical Examination , Rectal Neoplasms , Rectum , Recurrence , Salvage Therapy , Sigmoidoscopy , Treatment Outcome
18.
Einstein (Säo Paulo) ; 17(4): eAO4288, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012012

ABSTRACT

ABSTRACT Objective: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution™) in the utilization of these organs in Brazil. Methods: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). Results: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (±127.66mmHg); in the second hour, 214.2mmHg (±94.12mmHg); in the third hour, 214.4mmHg (±99.70mmHg); and in the fourth hour, 217.7mmHg (±73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). Conclusion: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.


RESUMO Objetivo: Avaliar a exequibilidade e o impacto da perfusão pulmonar ex vivo com solução hiperoncótica (Steen Solution™) na taxa de utilização desses órgãos no Brasil. Métodos: Neste estudo prospectivo, submetemos cinco pulmões considerados de alto risco para o transplante a 4 horas de perfusão pulmonar ex vivo, com avaliação da capacidade de oxigenação pulmonar. Os pulmões de doadores de alto risco foram definidos por critérios específicos, incluindo infiltrado inflamatório, edema pulmonar e pressão parcial de oxigênio arterial inferior a 300mmHg (fração inspirada de oxigênio de 100%). Resultados: Durante a reperfusão, a pressão parcial de oxigênio arterial (fração inspirada de oxigênio de 100%) média dos pulmões não sofreu alteração significativa (p=0,315). Na primeira hora, a pressão parcial de oxigênio arterial média foi de 302,7mmHg (±127,66mmHg); na segunda, 214,2mmHg (±94,12mmHg); na terceira, 214,4mmHg (±99,70mmHg); e na quarta, 217,7mmHg (±73,93mmHg). Os níveis plasmáticos de lactato e glicose se mantiveram estáveis ao longo da perfusão, sem diferença estatística na comparação entre os momentos estudados (p=0,216). Conclusão: A perfusão pulmonar ex vivo foi reproduzida em nosso centro e garantiu a preservação de pulmões durante o período de estudo, que foi de 4 horas. A técnica não promoveu melhora suficiente para indicação do órgão para o transplante e, portanto, não impactou na taxa de utilização desses órgãos.


Subject(s)
Humans , Male , Female , Adult , Organ Preservation/methods , Perfusion/methods , Tissue Donors , Lung Transplantation/methods , Brazil , Lung Compliance , Cross-Sectional Studies , Prospective Studies , Donor Selection , Lung/blood supply , Middle Aged
19.
Rev. Col. Bras. Cir ; 46(2): e2079, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003093

ABSTRACT

RESUMO Com a utilização crescente da máquina de perfusão no transplante renal, tem sido constatado que a isquemia dinâmica correlaciona-se à melhora da preservação orgânica. Nesse contexto, realizamos uma revisão sistemática que procurou avaliar a eficácia do uso de máquina de perfusão portátil (LifePort Kidney Transporter Machine®), utilizada no Brasil, comparada ao armazenamento estático, no que tange à função retardada do transplante renal de doadores com morte encefálica. Foi efetuada pesquisa bibliográfica, nas bases LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, SciELO, além de busca manual no Google acadêmico. A revisão sistemática, finalizada em abril 2017, foi constituída somente por ensaios clínicos randomizados. Para metanálise, foram avaliadas Razão de Risco e Razão de Chance. Foram identificados 86 documentos e selecionados, ao final, dois artigos com critérios de elegibilidade para metanálise, de grupos europeus e brasileiros. Nestes, 374 rins foram alocados para a máquina de perfusão, e igual número para o armazenamento estático. A função retardada do enxerto foi constatada em 84 e 110 pacientes, respectivamente. Na metanálise, foram obtidas uma Razão de Risco de 0,7568 (p=0,0151) e uma Razão de Chance de 0,6665 (p=0,0225), ambas com intervalo de confiança de 95%. A máquina de perfusão reduziu a incidência de função retardada do enxerto de doadores com morte encefálica.


ABSTRACT With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed a systematic review that aimed to evaluate the efficacy of the portable machine perfusion (LifePort Kidney Transporter Machine®), used in Brazil, compared to cold storage, regarding the delayed graft function of deceased donors with brain death. Literature search was carried out in LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, and SciELO, as well as in Google Scholar manually. The systematic review consisted only of randomized clinical trials. For meta-analysis, relative risk and odds ratio were evaluated. Eighty-six documents were identified and two papers from European and Brazilian groups were selected at the end, with eligibility criteria for meta-analysis. In these, 374 kidneys were assigned to machine perfusion and 374 kidneys were assigned to cold storage. Delayed graft function was observed in 84 and 110 patients, respectively. In meta-analysis, a risk ratio of 0.7568 (p=0.0151) and an odds ratio of 0.6665 (p=0.0225) were obtained, both with a 95% confidence interval. Machine perfusion reduced the incidence of delayed graft function of deceased donors with brain death.


Subject(s)
Humans , Organ Preservation/methods , Perfusion/methods , Brain Death , Cold Ischemia/methods , Kidney , Organ Preservation/instrumentation , Perfusion/instrumentation , Time Factors , Pulsatile Flow , Reproducibility of Results , Risk Factors , Kidney Transplantation/methods , Delayed Graft Function
20.
Einstein (Säo Paulo) ; 17(2): eAO4445, 2019. tab
Article in English | LILACS | ID: biblio-989776

ABSTRACT

ABSTRACT Objective To understand the profile of professionals working in organ harvesting, and analyze the learning results of those trained before and after the course on recovery, perfusion and packaging of organs for transplants. Methods A retroprospective, quantitative, analytical-descriptive study about the Course on Recovery, Perfusion and Packaging of Liver and Kidney, in the period from 2012 to 2014. Pre- and post-tests, with ten questions were used to assess knowledge about organ harvesting. The association of knowledge with applied content was verified by the McNemar test. Results Of the total of 334 participants, 187 (56.0%) were physicians, 104 (31.1%) nurses, and 43 (12.9%) scrub nurses. The majority of participants was male (58.4%), mean age of 39.1 years, 50% had graduated 5 to 10 years before, and 50.4% had less than one-year experience in organ harvesting. In knowledge assessment, there was an increase in the weighted mean, from 6.1 in the pre-test to 7.9 in the post-test. A significant increase in learning was observed in the post-test in 50% of scrub nurses, 33.3% in nurses 20% in physicians. Conclusion The professionals were starting work in organ harvesting, and most were from Southeastern, Northeastern and Northern regions. In terms of learning, the course contributed to enhancing knowledge of the multiprofessional health team, and represented better learning standard.


RESUMO Objetivo Conhecer o perfil dos profissionais que atuam em captação de órgãos e analisar o resultado da aprendizagem daqueles treinados antes e após o curso de extração, perfusão e acondicionamento de órgãos para transplantes. Métodos Estudo retroprospectivo, quantitativo, analítico-descritivo do Curso de Extração, Perfusão e Acondicionamento de Fígado e Rim, no período de 2012 a 2014. Utilizaram-se o pré e o pós-teste estruturado em dez questões, que avaliaram o conhecimento sobre captação de órgãos. A associação do conhecimento com o conteúdo aplicado foi verificada pelo teste McNemar. Resultados Do total de 334 participantes, 187 (56,0%) eram médicos, 104 (31,1%) enfermeiros e 43 (12,9%) instrumentadores. Houve predominância do sexo masculino (58,4%), com média de idade de 39,1 anos. Tinham entre 5 a 10 anos de formados 50% da amostra, e 50,4% tinham menos de 1 ano de experiência na área de captação de órgãos. Na avaliação do conhecimento, houve elevação na média geral ponderada de 6,1, no pré-teste, para 7,9, no pós-teste. Observou-se aumento significativo da aprendizagem no pós-teste em 50% nos instrumentadores, 33,3% nos enfermeiros e 20% nos médicos. Conclusão Os profissionais eram iniciantes na área de captação de órgãos e, em sua maioria, oriundos das Regiões Sudeste, Nordeste e Norte. No quesito de aprendizagem, o curso contribuiu para o aumento do conhecimento da equipe multiprofissional em saúde, representando ganho no padrão de aprendizagem.


Subject(s)
Humans , Male , Female , Adult , Organ Preservation , Clinical Competence , Product Packaging , Inservice Training , Learning , Retrospective Studies
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